Abstract

Introduction

Many supposed low-risk intensive care unit (ICU) admissions develop acute organ failure
(AOF). Identifying patients at high risk of developing AOF and targeting them with
preventative strategies may be effective. Our study question was: in a population
of ICU patients receiving positive pressure respiratory support (invasive or non-invasive)
in the absence of non-respiratory AOF, what is the 14-day incidence of, risk factors
for and time to acute organ failure?

Methods

In an international prospective cohort study, patients receiving positive pressure
respiratory support (invasive or non-invasive) in the absence of non-respiratory AOF
were enrolled and followed for 14 days. The primary outcome measure was the incidence
of any AOF (defined as SOFA 3 to 4) during follow-up.

Results

A total of 123 of 766 screened patients (16.1%) were enrolled. Data are reported for
121 patients. In total, 45 out of 121 patients (37.2%) developed AOF. Mortality rates
were higher in those with AOF: 17.8% versus 4.0% OR 5.11, P = 0.019) for ICU mortality; and 28.9% versus 11.8% (OR 2.80, P = 0.019) for hospital mortality. Median ICU length of stay was also longer in those
with AOF (11 versus 3.0 days; P < 0.0001). Hypoxemic respiratory failure (P = 0.001) and cardiovascular dysfunction (that is, SOFA 1 to 2; P = 0.03) were associated with AOF. The median time to first AOF was two days.

Conclusions

Patients receiving positive (invasive or non-invasive) pressure respiratory support
in the absence of non-respiratory AOF are commonly admitted to ICU; AOF is frequent
in these patients. Organ failure developed within a short period after admission.
Hypoxemic respiratory failure and cardiovascular dysfunction were strongly associated
with AOF.